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See detailClinical relevance of attentional biases in pediatric chronic pain: an eye-tracking study
Soltani, Sabine; van Ryckeghem, Dimitri UL; Vervoort, Tine et al

in Pain (in press)

Attentional biases have been posited as one of the key mechanisms underlying the development and maintenance of chronic pain and co-occurring internalizing mental health symptoms. Despite this theoretical ... [more ▼]

Attentional biases have been posited as one of the key mechanisms underlying the development and maintenance of chronic pain and co-occurring internalizing mental health symptoms. Despite this theoretical prominence, a comprehensive understanding of the nature of biased attentional processing in chronic pain and its relationship to theorized antecedents and clinical outcomes is lacking, particularly in youth. This study used eye-tracking to assess attentional bias for painful facial expressions and its relationship to theorized antecedents of chronic pain and clinical outcomes. Youth with chronic pain (n = 125) and without chronic pain (n = 52) viewed face images of varying levels of pain expressiveness while their eye gaze was tracked and recorded. At baseline, youth completed questionnaires to assess pain characteristics, theorized antecedents (pain catastrophizing, fear of pain, and anxiety sensitivity), and clinical outcomes (pain intensity, interference, anxiety, depression, and posttraumatic stress). For youth with chronic pain, clinical outcomes were reassessed at 3 months to assess for relationships with attentional bias while controlling for baseline symptoms. In both groups, youth exhibited an attentional bias for painful facial expressions. For youth with chronic pain, attentional bias was not significantly associated with theorized antecedents or clinical outcomes at baseline or 3-month follow-up. These findings call into question the posited relationships between attentional bias and clinical outcomes. Additional studies using more comprehensive and contextual paradigms for the assessment of attentional bias are required to clarify the ways in which such biases may manifest and relate to clinical outcomes. [less ▲]

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See detailGamified web-delivered attentional bias modification training for adults with chronic pain: Protocol for a randomized, double-blind, placebo-controlled trial
Vermeir, Julie F; White, Melanie J; Johnson, Daniel et al

in JMIR Research Protocols (2022)

Background: Research to date has found variable success in using attentional bias modification training (ABMT) procedures in pain samples. Several factors could contribute to these mixed findings ... [more ▼]

Background: Research to date has found variable success in using attentional bias modification training (ABMT) procedures in pain samples. Several factors could contribute to these mixed findings, including boredom and low motivation. Indeed, training paradigms are repetitive, which can lead to disengagement and high drop-out rates. A potential approach to overcome some of these barriers is to attempt to increase motivation and engagement through gamification (ie, the use of game elements) of this procedure. To date, research has yet to explore the gamified format of ABMT for chronic pain and its potential for transfer of benefits. Objective: The aim of this study is to investigate the effects of a gamified web-delivered ABMT intervention in a sample of adults with chronic pain via a randomized, double-blind, placebo-controlled trial. Methods: One hundred and twenty adults with chronic musculoskeletal pain, recruited from clinical (hospital outpatient waiting list) and non-clinical (wider community) settings, will be included in this randomized, double-blind, placebo-controlled, 3-arm trial. Participants will be randomly assigned to complete six online sessions of dot-probe non-gamified sham control ABMT, non-gamified standard ABMT, or gamified ABMT, across a period of three weeks. Active ABMT conditions will aim to train attention away from pain-relevant words. Participant outcomes will be assessed at pre-training, during training, immediately post-training and at 1-month follow-up. Primary outcomes include pain intensity, pain interference, and behavioral and self-reported engagement. Secondary outcomes include attentional bias for pain, anxiety, depression, interpretation bias for pain, and perceived improvement. Results: The ethical aspects of this research project have been approved by the Human Research Ethics Committees of the Royal Brisbane and Women’s Hospital (HREC/2020/QRBW/61743) and Queensland University of Technology (2000000395). This trial is currently in the active participant recruitment phase (since August 2021). Data collection and analysis are expected to conclude by October 2022 and January 2023, respectively. Conclusions: This trial will be the first to evaluate the effects of gamification techniques in a pain ABMT intervention. The findings will provide important information on the potential therapeutic benefits of gamified pain ABMT programs, shed light on the motivational influences of certain game elements in the context of pain, and advance our understanding of chronic pain. Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12620000803998 [less ▲]

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See detailThe impact of maternal child- and self-oriented pain-related injustice appraisals upon maternal attention to child pain, attention to anger, and pain-attending behavior
Baert, Fleur; van Ryckeghem, Dimitri UL; Sanchez-Lopez, Alvaro et al

in British Journal of Pain (2021)

Objectives The current study investigated the role of maternal child- and self-oriented injustice appraisals about child pain in understanding maternal attention for child pain and adult anger cues and ... [more ▼]

Objectives The current study investigated the role of maternal child- and self-oriented injustice appraisals about child pain in understanding maternal attention for child pain and adult anger cues and pain-attending behavior. Methods Forty-four children underwent a painful cold pressor task (CPT) while their mother observed. Eye tracking was used to measure maternal attention to child pain and adult anger cues. Initial attention allocation and attentional maintenance were indexed by probability of first fixation and gaze duration, respectively. Maternal pain-attending behaviors toward the child were videotaped and coded after CPT completion. Mothers also rated the intensity of pain and anger cues used in the free-viewing tasks. All analyses controlled for maternal catastrophizing about child pain. Results Neither child-oriented nor self-oriented injustice was associated with maternal attentional bias toward child pain. Regarding attention toward self-relevant anger cues, differential associations were observed for self- and child-oriented injustice appraisals, with maternal self-oriented injustice being associated with a greater probability of first fixating on anger and with higher anger ratings, whereas maternal child-oriented injustice was associated with enhanced attentional maintenance toward anger. Neither type of maternal injustice appraisals was associated with maternal pain-attending behavior, which was only associated with maternal catastrophizing. Conclusions The current study sheds light on potential differential mechanisms through which maternal self- vs. child-oriented injustice appraisals may exert their impact on parent and child pain-related outcomes. Theoretical implications and future directions are discussed. [less ▲]

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See detailCan perioperative psychological interventions decrease the risk of post-surgical pain and disability? A systematic review and meta-analysis of randomized controlled trials
Nadinda, Putu G; van Ryckeghem, Dimitri UL; Peters, Madelon L

in Pain (2021)

Many patients experience pain after surgery. Psychological factors such as emotion and cognition are shown to be associated with the development of acute and chronic post-surgical pain. Therefore, the ... [more ▼]

Many patients experience pain after surgery. Psychological factors such as emotion and cognition are shown to be associated with the development of acute and chronic post-surgical pain. Therefore, the question arises whether targeting these psychological factors can reduce negative post-surgical outcomes. The aim of the current review is to investigate the efficacy of perioperative psychological interventions in reducing (sub)acute and chronic post-surgical pain and disability in adults. Randomized controlled trials were identified through four databases (Web of Science, PsycINFO, PubMed, and CINAHL). The outcomes of interest were (sub)acute (i.e., within 3 months after surgery) and chronic (> 3 months after surgery) pain and disability. After screening, 21 studies were included in the final analyses. It was found that psychological interventions significantly reduced (sub)acute pain (d = -0.26, 95% CI [-0.48 to -0.04]), and disability (d = -0.43, 95% CI [-0.84 to -0.03]), as well as chronic post-surgical pain (d = -0.33, 95% CI [-0.61 to -0.06]), and disability (d = -0.43, 95% CI [-0.68 to -0.18]). Additionally, interventions delivered after surgery and interventions delivered by a psychologist tended to be more effective than interventions delivered before surgery and interventions delivered by another healthcare provider. Furthermore, the current review points to the need for more research to determine which specific type of intervention may be most beneficial for surgical patients. Finally, the current review identified that research in this domain has concerns regarding bias in missing outcomes data due to withdrawal and drop out. [less ▲]

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See detailThe Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain
Wauters, Aline; Noel, Melanie; van Ryckeghem, Dimitri UL et al

in Journal of Pain (2021), 22(10), 1303-1314

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing ... [more ▼]

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing and negatively-biased pain memories. Youth with chronic pain (N = 105) performed a cold pressor task (CPT) and completed self-report measures of state/trait pain catastrophizing and attention control, with the latter comprising both attention focusing and attention shifting. Two weeks after the CPT, youth's pain-related memories were elicited via telephone allowing to compute pain and anxiety memory bias indices (ie, recalling pain intensity or pain-related anxiety, respectively, as higher than initially reported). Results indicated no main effects of attention control and pain catastrophizing on pain memories. However, both components of attention control (ie, attention focusing and attention shifting) moderated the impact of pain catastrophizing on youth's memory bias, with opposite interaction effects. Specifically, whereas high levels of attention shifting buffered the influence of high pain catastrophizing on the development of pain memory bias, high levels of attention focusing strengthened the influence of high pain catastrophizing on the development of anxiety memory bias. Interaction effects were confined to trait catastrophizing (ie, not state catastrophizing). Theoretical and clinical implications are discussed. PERSPECTIVE: This article investigates the role of attention control in the development of negatively-biased pain memories in children with chronic pain. Findings underscore the importance of targeting differential components of attention control and can inform intervention efforts to minimize the development of negatively biased pain memories in youth with chronic pain. [less ▲]

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See detailWhen, why, and how do People Deviate from Physical Distancing Measures During the COVID-19 Pandemic: A Mixed-Methods Study
Van Alboom, Maité; Baert, Fleur; Wauters, Aline et al

in Psychologica Belgica (2021)

To limit the spread of COVID-19, many countries, including Belgium, have installed physical distancing measures. Yet, adherence to these newly installed behavioral measures has been described as ... [more ▼]

To limit the spread of COVID-19, many countries, including Belgium, have installed physical distancing measures. Yet, adherence to these newly installed behavioral measures has been described as challenging and effortful. Based on the Health Action Process Approach (HAPA) model, this study performed an in-depth evaluation of when, why, and how people deviated from the physical distancing measures. An online mixed-method study was conducted among Belgian adults (N = 2055) in the beginning of May 2020. Participants were recruited via an open call through email and social media platforms, using snowball sampling. Conditions wherein people deviated from the physical distancing measures were assessed by means of an open-ended question. HAPA determinants were assessed in a quantitative way. Half of the sample reported to deviate from the measures. Further, deviation from the measures was associated with each determinant outlined by the HAPA. Findings highlight that many people deviated from the measures because of their need for social contact. The majority of the people who deviated from the measures stated that they carefully weighed the risks of their behavior. Need for social contact pushed people to deviate from physical distancing measures in a deliberate manner. Potential areas for future interventions aimed at promoting adherence to physical distancing measures and enhancing psychosocial well-being are discussed. [less ▲]

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See detailChronic primary pain in the COVID-19 pandemic: how uncertainty and stress impact on functioning and suffering
Meulders, Ann; Vlaeyen, Johan W S; Evers, Andrea W M et al

in Pain (2021)

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See detailRacial disparities in observers' attention to and estimations of others' pain
Kissi, Ama; van Ryckeghem, Dimitri UL; Mende-Siedlecki et al

in Pain (2021)

Research has demonstrated racial disparities in pain care such that Black patients often receive poorer pain care than White patients. Little is known about mechanisms accounting for the emergence of such ... [more ▼]

Research has demonstrated racial disparities in pain care such that Black patients often receive poorer pain care than White patients. Little is known about mechanisms accounting for the emergence of such disparities. The present study had 2 aims. First, we examined whether White observers' attentional processing of pain (using a visual search task [VST] indexing attentional engagement to and attentional disengagement from pain) and estimation of pain experience differed between White vs Black faces. Second, we examined whether these differences were moderated by (1) racially biased beliefs about pain experience and (2) the level of pain expressed by Black vs White faces. Participants consisted of 102 observers (87 females) who performed a VST assessing pain-related attention to White vs Black avatar pain faces. Participants also reported on racially biased beliefs about White vs Black individuals' pain experience and rated the pain intensities expressed by White and Black avatar faces. Results indicated facilitated attentional engagement towards Black (vs White) pain faces. Furthermore, observers who more strongly endorsed the belief that White individuals experience pain more easily than Black individuals had less difficulty disengaging from Black (vs White) pain faces. Regarding pain estimations, observers gave higher pain ratings to Black (vs White) faces expressing high pain and White (vs Black) faces expressing no pain. The current findings attest to the importance of future research into the role of observer attentional processing of sufferers' pain in understanding racial disparities in pain care. Theoretical and clinical implications are discussed, and future research directions are outlined. [less ▲]

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See detailWhat do alexithymia items measure? A discriminant content validity study of the Toronto-alexithymia-scale–20
Veirman, Elke; van Ryckeghem, Dimitri UL; Verleysen, Gregory et al

in PeerJ (2021), 29

Background Questions have been raised about whether items of alexithymia scales assess the construct alexithymia and its key features, and no other related constructs. This study assessed the ... [more ▼]

Background Questions have been raised about whether items of alexithymia scales assess the construct alexithymia and its key features, and no other related constructs. This study assessed the (discriminant) content validity of the most widely used alexithymia scale, i.e., the Toronto Alexithymia Scale (TAS-20). Methods Participants (n = 81) rated to what extent TAS-20 items and items of related constructs were relevant for assessing the constructs ‘alexithymia’, ‘difficulty identifying feelings’, ‘difficulty describing feelings’, ‘externally-oriented thinking’, ‘limited imaginal capacity’, ‘anxiety’, ‘depression’, and ‘health anxiety’. Results Results revealed that, overall, the TAS-20 did only partly measure ‘alexithymia’. Only the subscales ‘difficulty identifying feelings’ and ‘difficulty describing feelings’ represented ‘alexithymia’ and their intended construct, although some content overlap between these subscales was found. In addition, some items assessed (health) anxiety equally well or even better. Conclusions Revision of the TAS-20 is recommended to adequately assess all key features of alexithymia. Findings with the TAS-20 need to be interpreted with caution in people suffering from medical conditions. [less ▲]

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See detailThe impact of mental and somatic stressors on physical activity and sedentary behaviour in adults with type 2 diabetes mellitus: a diary study
Poppe, Louise; De Paepe; van Ryckeghem, Dimitri UL et al

in PeerJ (2021), 9

Background Adopting an active lifestyle is key in the management of type 2 diabetes mellitus (T2DM). Nevertheless, the majority of individuals with T2DM fails to do so. Additionally, individuals with T2DM ... [more ▼]

Background Adopting an active lifestyle is key in the management of type 2 diabetes mellitus (T2DM). Nevertheless, the majority of individuals with T2DM fails to do so. Additionally, individuals with T2DM are likely to experience mental (e.g., stress) and somatic (e.g., pain) stressors. Research investigating the link between these stressors and activity levels within this group is largely lacking. Therefore, current research aimed to investigate how daily fluctuations in mental and somatic stressors predict daily levels of physical activity (PA) and sedentary behaviour among adults with T2DM. Methods Individuals with T2DM (N = 54) were instructed to complete a morning diary assessing mental and somatic stressors and to wear an accelerometer for 10 consecutive days. The associations between the mental and somatic stressors and participants’ levels of PA and sedentary behaviour were examined using (generalized) linear mixed effect models. Results Valid data were provided by 38 participants. We found no evidence that intra-individual increases in mental and somatic stressors detrimentally affected participants’ activity levels. Similarly, levels of sedentary behaviour nor levels of PA were predicted by inter-individual differences in the mental and somatic stressors. [less ▲]

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See detailCohort profile: DOLORisk Dundee: a longitudinal study of chronic neuropathic pain
Hébert, Harry L; Veluchamy, Abirami; Baskozos, Georgios et al

in BMJ Open (2021), 11(5),

Purpose: Neuropathic pain is a common disorder of the somatosensory system that affects 7%-10% of the general population. The disorder places a large social and economic burden on patients as well as ... [more ▼]

Purpose: Neuropathic pain is a common disorder of the somatosensory system that affects 7%-10% of the general population. The disorder places a large social and economic burden on patients as well as healthcare services. However, not everyone with a relevant underlying aetiology develops corresponding pain. DOLORisk Dundee, a European Union-funded cohort, part of the multicentre DOLORisk consortium, was set up to increase current understanding of this variation in onset. In particular, the cohort will allow exploration of psychosocial, clinical and genetic predictors of neuropathic pain onset. Participants: DOLORisk Dundee has been constructed by rephenotyping two pre-existing Scottish population cohorts for neuropathic pain using a standardised 'core' study protocol: Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) (n=5236) consisting of predominantly type 2 diabetics from the Tayside region, and Generation Scotland: Scottish Family Health Study (GS:SFHS; n=20 221). Rephenotyping was conducted in two phases: a baseline postal survey and a combined postal and online follow-up survey. DOLORisk Dundee consists of 9155 participants (GoDARTS=1915; GS:SFHS=7240) who responded to the baseline survey, of which 6338 (69.2%; GoDARTS=1046; GS:SFHS=5292) also responded to the follow-up survey (18 months later). Findings to date: At baseline, the proportion of those with chronic neuropathic pain (Douleur Neuropathique en 4 Questions questionnaire score ≥3, duration ≥3 months) was 30.5% in GoDARTS and 14.2% in Generation Scotland. Electronic record linkage enables large scale genetic association studies to be conducted and risk models have been constructed for neuropathic pain. Future plans: The cohort is being maintained by an access committee, through which collaborations are encouraged. Details of how to do this will be available on the study website (http://dolorisk.eu/). Further follow-up surveys of the cohort are planned and funding applications are being prepared to this effect. This will be conducted in harmony with similar pain rephenotyping of UK Biobank. [less ▲]

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See detailAcceptance is not acceptance, but acceptance!
van Ryckeghem, Dimitri UL

Report (2021)

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See detailAssessment and Measurement in Health Psychology
van Ryckeghem, Dimitri UL; Crombez, Geert

in Reference Module in Neuroscience and Biobehavioral Psychology (2021)

Sound assessment and measurement is at the heart of every discipline, including health psychology. Within the current chapter, we address several key issues of assessment and measurement in health ... [more ▼]

Sound assessment and measurement is at the heart of every discipline, including health psychology. Within the current chapter, we address several key issues of assessment and measurement in health psychology. We discuss the strengths and weaknesses of commonly used methodologies in health psychology research and clinic, including questionnaire assessment and ecological momentary assessment, as well as potential pitfalls in using these assessment methods. Next, we discuss three pivotal features of assessment (i.e. reliability, validity, and responsiveness) and their importance for assessment of health psychological constructs. Last, we discuss some examples of tools to assess health outcomes in research and evidence-based practice as well as future directions in the field of health psychology assessment. [less ▲]

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See detailAltered regulation of negative affect in patients with fibromyalgia : a diary study
Rost, Silke; Crombez, Geert; Stefan Sütterlin, Stefan et al

in EUROPEAN JOURNAL OF PAIN (2021)

Background Fibromyalgia is characterized by widespread musculoskeletal pain and often accompanied by cognitive and emotional problems. Adaptation to fibromyalgia may therefore also rely on one's ability ... [more ▼]

Background Fibromyalgia is characterized by widespread musculoskeletal pain and often accompanied by cognitive and emotional problems. Adaptation to fibromyalgia may therefore also rely on one's ability to regulate emotional problems. In this study, we examined two indices of emotion regulation, that is, (a) affective instability, involving frequent large fluctuations in self-reported affect, and (b) resting heart rate variability (HRV). 45.4 years; 39 females) and 46 matched healthy controls (M-age = 44.9 years; 37 females). Heart rate was monitored under resting conditions to derive HRV. Subsequently, participants completed an electronic end-of-day diary for 14 consecutive days assessing daily levels of pain, disability, negative affect (NA) and positive affect (PA). Affective instability was operationalized as the mean square of successive differences in daily mood. Results Results indicate increased levels of NA instability and reduced levels of HRV in patients with fibromyalgia in comparison with healthy controls. Furthermore, HRV and NA instability were inversely related. Finally, in patients, higher NA instability was related to increased pain disability. Conclusions Current findings support the idea that patients with fibromyalgia are confronted with fluctuating emotions. These results may have important implications for treatment as they provide support for the use of emotion regulation skills training in patients with fibromyalgia to impact upon NA instability. Significance This study provides novel insight in the link between emotion regulation indices,that is, heart-rate variability and negative affective (NA) instability, in patients with fibromyalgia, and presents evidence for differences in both emotion regulation indices between patients with fibromyalgia and healthy people. Furthermore, results link increased NA instability with increased levels of daily disability in patients with fibromyalgia. Together, these findings offer support for a key role of emotion regulation in fibromyalgia outcomes, providing pathways for clinical practice. [less ▲]

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See detailMotor action changes pain perception : a sensory attenuation paradigm in the context of pain
Pinto, Eleana; van Ryckeghem, Dimitri UL; Meulders, Ann et al

in PAIN (2021)

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See detailThe Impact of Parental Presence on their Children during Painful Medical Procedures:A Systematic Review
Rheel, Emma; Malfliet, Anneleen; van Ryckeghem, Dimitri UL et al

in Pain Medicine (2021), 28

Objective: Whether parental presence during their children's painful medical procedures is advantageous with regard to child's pain-related outcomes is questionable. Research regarding this topic is ... [more ▼]

Objective: Whether parental presence during their children's painful medical procedures is advantageous with regard to child's pain-related outcomes is questionable. Research regarding this topic is equivocal and additional questions, such as whether levels of parental involvement may play a role as well, remain to be assessed. The purpose of this systematic review is to summarize and critically appraise the literature regarding the impact of parental presence versus absence during their children's painful medical procedures on the child's pain-related outcomes. Methods: The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2157 participants. Studies were considered eligible if they included children (≤ 18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure. Results: The children's pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence versus absence with regard to children's self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children's self-reported fears, anxiety and distress, and observed pain-related behaviors. Conclusions: : In order to provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review. [less ▲]

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See detailThe effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study
Rheel, Emma; Ickmans, Kelly; Wauters, Aline et al

in European Journal of Pain (2021), 25(10), 2094-2111

Background: Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of ... [more ▼]

Background: Pain neuroscience education (PNE) has received increasing research attention demonstrating beneficial effects on pain-related outcomes in adults. Conversely, studies on the effectiveness of PNE in children are scarce. Methods: This study investigated the effect of a pain educational video intervention on child pain-related outcomes (i.e. experienced pain intensity, pain-related fear and catastrophic worry about pain, pain threshold and pain knowledge) in healthy children undergoing an experimental pain task. Furthermore, the moderating role of children's demographic (i.e. sex and age) and psychological (i.e. baseline pain knowledge and anticipated pain intensity, pain-related fear and catastrophic worry) characteristics was examined. Participants were 89 children (Mage = 11.85, SD = 1.78), randomly assigned to either a condition whereby they were instructed to watch a brief pain educational video (i.e. experimental group) or to a control condition whereby they did not watch any video. Results: Study findings revealed that accurate pain knowledge and pain threshold were higher amongst children in the experimental group compared to the control group. In contrast with expectations, no main effects of the video intervention were observed for experienced pain intensity, pain-related fear and catastrophic worry. Moderation analyses indicated that the video intervention contributed, in comparison with the control condition, to higher levels of pain knowledge amongst younger children only and to higher pain thresholds amongst boys only. Conclusions: Further investigation is needed to optimize pain educational video interventions and to determine whether more beneficial outcomes can be found in clinical (i.e. non-experimental) situations and in children with persistent or recurring pain problems. Significance: Examining the impact of pain educational interventions within a non-clinical setting is deemed particularly important given that adaptive pain coping strategies likely play an important role in preventing the development and maintenance of future maladaptive pain-related behaviour. Further, study findings provide preliminary evidence of baseline and demographic (i.e. age and sex) characteristics explaining differences in the effect of a pain educational video intervention in pain knowledge and pain-related experiences during experimental pain. [less ▲]

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